ELECTROSURGICAL TISSUE DISSECTING DEVICE
Electrosurgical devices, methods, and systems for electrosurgical procedures as enabled by bipolar radiofrequency energy. An electrosurgical tissue dissecting device includes a shaft, two jaws extending from the shaft, a first electrode that is positioned on either one or both of the jaws, and a second electrode that is positioned at least partially between the two jaws.
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This application claims priority to U.S. Provisional Patent Application No. 61/502,268, filed Jun. 28, 2011, the contents of which are incorporated by reference herein in their entirety for any and all purposes.
FIELD OF THE INVENTIONThe disclosed technology relates to systems and methods for electrosurgery. More particularly, the technology relates to devices, methods, and systems of electrosurgical tissue dissection and tissue sealing.
BACKGROUND OF THE INVENTIONThe technology provided in this disclosure relates to electrosurgical devices, methods, and systems for electrosurgical procedures as enabled by bipolar radiofrequency energy.
SUMMARY OF THE INVENTIONThe technology provided in this disclosure relates to electrosurgical devices, methods, and systems for electrosurgical procedures as enabled by bipolar radiofrequency energy. Some technology embodiments are dedicated to electrosurgical dissection, other embodiments include a combination of electrosurgical dissection and tissue sealing capabilities. A dual modality device advantageously allows a minimization of device laparoscopic entry-exit events during a surgical procedure that involves (or may involve) both electrosurgical dissection and sealing.
Examples of embodiments of the technology are provided hereinafter. Particular technology features are described in the context of these various embodiments. Technology features that may be described or depicted in any one particular embodiment may also be applied to any other embodiment.
In the alternative configuration shown in
A second group of embodiments of the technology shown in
More particularly,
The electrode assembly 24 includes a pair of bipolar electrodes, including a first electrode and a second electrode. More particularly, the first and second tines 26 act collectively as a first bipolar electrode 26′. The second electrode 30 is in the form of an electrosurgical blade 30′ and is disposed orthogonally across a proximal aspect of the gap 27 between the tines 26. An isolator layer 32 electrically separates the first and second electrodes 26′ and 30.
Tissue that comes into contact with either or both of the tines 26 and the electrosurgical blade 30′ at the same time is subject to dissection by electrosurgical energy delivered by the device. The tines 26 are fixed such that they are not pivotable with respect to each other, however, the tines 26 are pivotable with respect to the shaft 23 about a pivot point 25. Alternatively, the tines 26 may be fixed to the shaft 23 such that the tines 26 can not pivot with respect to the shaft 23.
In
Bipolar electrodes 36 and 38 are arranged in
In the second group of embodiments of the technology shown in
In various embodiments of the opposable jaws of
When the electrosurgical blade 38′ of
The device 39 shown in
Additionally, the construction of the electrode assembly of
A third group of embodiments of the technology shown in
The third group of embodiments shown in
One embodiment of this third embodiment shown in
Embodiments of the blade 55 are configured to be moveable from a home position (see
In some of the devices of the third embodiment shown in
The electrode assemblies of
In some of the devices 51 of
A variety of other mechanisms may allow the electrosurgical blade 55 to be projected beyond the longitudinal profile of the distally directed member 57. For example, in some embodiments of
With regard to being configured to be able to cut to a controlled depth, when the electrosurgical blade 55 is positioned in an outwardly projected position (see
In the device of
In the device of
In the device of
In the device of
A fourth embodiment of the technology shown in
The device 60 includes at least three electrodes, i.e., two electrosurgical jaws 62a and 62b and an electrosurgical blade 66, which collectively are configured to be able to operate in tissue sealing and tissue dissecting modalities. Accordingly, the device 60 includes at least three electrodes (i.e., a first electrode 62a′, a second electrode 62b′, and a third electrode 64′), a pair of opposing jaws 62 (i.e., a first jaw 62a and a second jaw 62b), and a pivotable electrosurgical blade 64.
The first opposable jaw 62a comprises the first electrode 62a′, the second opposable 62b jaw comprises the second electrode 62b′, and the pivotable electrosurgical blade 64 comprises the third electrode 64′. The electrosurgical blade 64 is pivotably-attached to the second jaw 62b at a first end 66 and unattached at the second end 68. The first and second electrodes 62a′ and 62b′ are operable together as a bipolar electrode pair, and the first and second electrodes 62a′ and 62b′ are collectively operable as a single electrode that operates together with the third electrode 64′ as a bipolar electrode pair.
The device 60 may be configured for tissue sealing by grasping a portion of tissue between the two opposable jaws 62. In a procedure or portion of a procedure that includes a tissue sealing event, the first and second jaws 62 are the operative as paired bipolar electrodes. Aspects of the mechanics and electrical dynamics of tissue sealing are described in other related patent applications: application Ser. No. 12/121,734 filed May 15, 2008; application Ser. No. 09/169,019 filed Oct. 8, 1998 now U.S. Pat. No. 6,123,701 issued Sep. 26, 2000; application Ser. No. 13/021,633 filed Feb. 4, 2011; application Ser. No. 13/096,912 filed Apr. 28, 2011; application Ser. No. 13/070,391 filed Mar. 23, 2011; application Ser. No. 13/110,848 filed May 18, 2011; application Ser. No. 13/021,633 filed Feb. 4, 2011; application Ser. No. 12/907,646 filed Oct. 19, 2010, each of which are incorporated by reference herein in their entirety.
The electrosurgical device 60 of
In the first operational arrangement of the device 60, the electrode assembly is arranged to kinetically dissect tissue with the jaws open, and the electrosurgical blade 64 is positioned between the jaws 62. The term ‘kinetic dissection’ refers to dissection that is driven by manual movement of the electrode assembly, or the device 60 as a whole, by the operator. Thus, the operational arrangement includes positioning the first and second jaws 62 in an open position (see
In some embodiments being configured for tissue dissecting comprises being configured for a kinetic or distally-advancing cutting with a bilaterally supported blade. Distally-advancing cutting relates to operator controlled movement of the electrode assembly. A bilaterally-supported blade includes stable support at the end of the blade that is pivotably attached to the second jaw 62b, and stabilization or retention of the free end of the blade within the gap formed between the open jaws. When the jaws of the electrode assembly are in an open position, the height ‘h’ (see
In the second operating arrangement of the device 60, the electrode assembly is arranged to kinetically dissect tissue with the jaws 62 closed or substantially closed, as shown in
In some embodiments, being configured for operator-driven movement of the electrode assembly comprises being configured to dissect tissue in accordance with any of distally directed translational movement, proximally directed translational movement, or lateral movement.
In some embodiments, being configured for tissue dissecting comprises being configured for cutting with a unilaterally supported blade. And, in some embodiments, tissue dissecting comprises operator driven movement cutting that cuts a portion of tissue that is limited by a length of the blade.
According to another aspect of the invention, the device 60, which combines tissue dissection and tissue sealing capability, includes an electrode assembly that includes: a pair of opposable jaws 62, a first jaw 62a and a second jaw 62b, wherein the first and second jaws 62 are rotationally joined at their respective proximal ends 70 such that the jaws 62 may pivot between an open position and a closed position, the open position creating a gap 27 between the two jaws 62; and a pivotable electrosurgical blade 64 rotationally joined to the second jaw 62b, the blade 64 pivotably configured to be stabilized in a first, second, and third position.
In a first position, the blade 64 (see
Several operational arrangements of the electrode assembly of the device 60 can be made, each being associated with a particular electrosurgical modality, as will be described hereinafter.
(1) When the jaws 62 are in an open position and when the electrosurgical blade 64 is in the parked position, the gap 27 between the first and second jaws 62 allows positioning of the first and second electrodes 62a′ and 62b′ such that they are configured to perform sealing of tissue portions that may be captured within the jaws 62.
(2) When the jaws 62 are in an open position and when the electrosurgical blade 64 is in the second position, the first and third electrode 62a′ and 64′ are positioned to perform distally advancing tissue dissection by the blade 64 as it is supported bilaterally.
(3) When the jaws 62 are in a closed position, and when the blade is pivotably positioned external to the second jaw 62b, the second and third electrodes 62b′ and 64′ are positioned to perform operator-movement driven tissue dissection by blade as it is unilaterally supported.
The device 60 further comprises an isolator layer 63 separating first and second electrodes 62a′ and 62b′ when the blade 64 is in the second position of
According to one exemplary method of using the device of
Although the jaws 36 of
Embodiments of the provided technology include methods of using devices of
In some embodiments of this electrosurgical dissection method, the advancing of the electrode assembly and delivering energy steps are performed simultaneously or in at least partially overlapping fashion. And in some embodiments, the tissue dissection trap remains in an open position continuously or substantially continuously while engaging the portion of the tissue sheet.
In a method of electrosurgical dissection that involves the use of the devices of
With regard to a method of electrosurgery involving the use of the devices of
In some embodiments of this method, making use of the devices of
With regard to electrosurgical tissue sealing with the device 60 of
With regard to electrosurgical tissue dissecting device according to the device 60 of
Further with regard to electrosurgical dissecting, embodiments of the method may comprise cutting through a portion of a tissue sheet along a line of dissection. With regard to these embodiments, wherein along the line of dissection, the tissue sheet has a thickness no greater than a height of a cutting window of the bipolar electrode assembly, such cutting window being limited at least by the height of a gap between the distal tips of the opposing jaws when the jaws are in an open position.
With regard to electrosurgical dissecting, embodiments of the method may comprise dissecting with the electrosurgical blade when it is positioned external to the second jaw, projecting at an angle. In such an arrangement, the blade is unilaterally supported at the point of its pivotable attachment to the second jaw.
Embodiments of this method electrosurgical dissecting may include moving an electrosurgical cutting blade through a surface aspect of a tissue portion in any of three directions, a distal direction, a proximal direction, or a lateral direction. Embodiments may further include cutting a line of dissection into a portion of a tissue to a controlled depth.
Embodiments of the provided technology include devices and systems that incorporate embodiments of the electrode assemblies as summarized above. Devices thus may include any of the described electrode assemblies; a shaft supporting the electrode assembly; and a hand piece supporting the shaft. Embodiments may further include a rotational mechanism configured to rotate the shaft and the electrode assembly with respect to the hand piece, and/or they may include an articulating assembly disposed between the electrode assembly and the shaft. The scope of each embodiment described or depicted should be understood to include technology features described or depicted in the context of any other particular embodiment.
Some device and electrode assembly embodiments are sized and configured to be able to enter and operate in a laparoscopic space through currently available commercial trocars, including 5 mm diameter trocars. In these particular embodiments, therefore, both the shaft and the electrode assembly (in a closed state or arrangement) are of a sufficiently narrow diameter that they can easily pass through a 5 mm trocar.
Systems as provided by the technology may include any of described or depicted devices, as well as a generator operably connected to the electrosurgical device. Some embodiments of the generator are operable to deliver RF energy to the electrodes in any waveform selected from the group comprising a continuous cutting RF voltage waveform, a blended waveform with a continuous RF voltage waveform with a duty cycle of less than 100%, and a coagulation waveform comprising pulsed RF voltage. Further details of energy delivery capability are shown in Table 1.
Electrical Algorithm Parameters: Energy Delivery RangesTable 1 provides example ranges of operating parameters for the electrosurgical tissue sealing and the electrosurgical tissue dissecting operating modalities of embodiments of the technology. Embodiments of systems that are dedicated to dissecting are enabled to deliver energy within the parameters of dissecting energy. Embodiments of systems with electrode assemblies that are configured for dual purposes of both sealing and dissecting are enabled to deliver energy consistent with the parameters for both tissue sealing and tissue dissection.
Claims
1. An electrosurgical tissue dissecting device comprising:
- a shaft;
- two jaws extending from the shaft;
- a first electrode that either forms part of or is positioned on either one or both of the jaws; and
- a second electrode that is positioned at least partially between the two jaws.
2. The electrosurgical tissue dissecting device of claim 1, wherein the jaws are movable with respect to the shaft.
3. The electrosurgical tissue dissecting device of claim 1, wherein at least one of the jaws is moveable with respect to the other jaw.
4. The electrosurgical tissue dissecting device of claim 1, wherein the jaws are each pivotable with respect to each other.
5. The electrosurgical tissue dissecting device of claim 1, wherein the jaws are fixed in position with respect to each other.
6. The electrosurgical tissue dissecting device of claim 1 further comprising an isolating layer positioned adjacent the second electrode.
7. The electrosurgical tissue dissecting device of claim 1, wherein both jaws comprise the first electrode.
8. The electrosurgical tissue dissecting device of claim 1, wherein one end of the second electrode is pivotably mounted to one of the two jaws.
9. The electrosurgical tissue dissecting device of claim 8, wherein another end of the second electrode is positionable through an aperture that is disposed in the other of the two jaws.
10. The electrosurgical tissue dissecting device of claim 1, wherein the second electrode is a blade having a sharp edge for dissecting tissue.
11. The electrosurgical tissue dissecting device of claim 1 wherein one of the two jaws is configured as the first electrode and other of the two jaws is configured as a third electrode.
12. An electrosurgical tissue dissecting device comprising:
- a shaft;
- a distally directed member that extends in a distal direction from the shaft;
- a first electrode that either forms part of or is positioned on the distally directed member; and
- a second electrode that is configured to pivot with respect to the first electrode.
13. The electrosurgical tissue dissecting device of claim 12, wherein a distal end of the second electrode is pivotably connected to the distally directed member and a proximal end of the second electrode is configured to pivot with respect to the first electrode about a pivot point that is defined at the distal end of the second electrode.
14. The electrosurgical tissue dissecting device of claim 12, wherein a proximal end of the second electrode is pivotably connected to the distally directed member and a distal end of the second electrode is configured to pivot with respect to the first electrode about a pivot point that is defined at the proximal end of the second electrode.
15. The electrosurgical tissue dissecting device of claim 12, wherein the second electrode comprises a linkage that includes two links that are pivotably connected together, wherein one end of the linkage is configured to pivot with respect to the first electrode and the other end of the linkage is configured to slide with respect to the first electrode.
16. The electrosurgical tissue dissecting device of claim 15 further comprising an isolating layer that either forms part of or is connected to the distally directed member, wherein said other end of the linkage is configured to slide in a slot that is formed in the isolating layer.
17. The electrosurgical tissue dissecting device of claim 12 further comprising an isolating layer that either forms part of or is connected to the distally directed member, wherein the second electrode is pivotably connected to the isolating layer.
18. The electrosurgical tissue dissecting device of claim 12 wherein the second electrode is a flexible member that is biased in a direction away from the distally directed member.
19. An electrosurgical tissue dissecting device that accomplishes dissection and sealing, said device comprising:
- a shaft;
- two jaws extending from the shaft;
- a first electrode that is either connected to or forms part of one of the two jaws;
- a second electrode that is either connected to or forms part of the other of the two jaws; and
- a third electrode disposed at least partially between the two jaws.
20. The electrosurgical tissue dissecting device of claim 19, wherein the jaws are pivotable with respect to each other.
21. The electrosurgical tissue dissecting device of claim 19, wherein one end of the third electrode is pivotably mounted to one of the two jaws.
22. The electrosurgical tissue dissecting device of claim 21, wherein another end of the second electrode is positionable through an aperture that is formed in the other of the two jaws.
23. The electrosurgical tissue dissecting device of claim 21, wherein another end of the second electrode is positionable through an aperture that is formed in said one of the two jaws.
Type: Application
Filed: Jun 28, 2012
Publication Date: Jan 3, 2013
Patent Grant number: 9339327
Applicant: AESCULAP AG (Tuttlingen)
Inventor: Timothy A. Koss (Discovery Bay, CA)
Application Number: 13/536,149
International Classification: A61B 18/14 (20060101);